短节段 Barrett 食管与长节段 Barrett 食管进展为食管腺癌的年发生率较低。
Lower Annual Rate of Progression of Short-Segment vs Long-Segment Barrett's Esophagus to Esophageal Adenocarcinoma.
机构信息
Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas; Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri.
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri.
出版信息
Clin Gastroenterol Hepatol. 2019 Apr;17(5):864-868. doi: 10.1016/j.cgh.2018.07.008. Epub 2018 Aug 8.
BACKGROUND & AIMS: European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm).
METHODS
We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression.
RESULTS
We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07%) than of patients with LSBE (0.25%) (P = .001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29%) compared to compared to LSBE (0.91%) (P < .001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95% CI, 0.18-0.57; P < .001).
CONCLUSION
We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07%/year) than of LSBE (0.25%/year). We propose lengthening current surveillance intervals for patients with SSBE.
背景与目的
欧洲指南根据节段长度建议不同的非异型性 Barrett 食管（NDBE）监测间隔，而美国指南则根据 BE 长度建议监测间隔。我们使用最新指南（长度≥1 cm）中 BE 的定义，研究了短节段 BE 患者（NDBE）进展为高级别异型增生（HGD）或食管腺癌（EAC）的比率。
方法
我们收集了 7 家三级转诊中心内镜检查发现的 1883 例 NDBE 患者的人口统计学、临床、内镜和组织病理学数据（平均年龄 57.3 岁；83.5%为男性；88.1%为白种人）。中位随访时间为 6.4 年。索引内镜检查后 1 年内发现的异型增生或 EAC 病例被视为现患病例，并予以排除。使用对数秩检验比较短（≥1 且＜3）和长（≥3）BE 长度患者之间进展为 HGD 或 EAC 的未调整率。对有记录的布拉格 C&M 分类的患者进行了亚组分析。我们使用多变量比例风险模型评估 BE 长度与进展之间的关系。在调整与进展相关的变量后，计算调整后的危险比。
结果
我们发现 822 例患者存在短节段 BE（SSBE），1061 例患者存在长节段 BE（LSBE）。与 LSBE 患者（0.25%）相比，SSBE 患者的 EAC 年进展率（0.07%）显著较低（P=0.001）。对于 HGD 或 EAC 的联合终点，SSBE 患者的年进展率（0.29%）明显低于 LSBE 患者（0.91%）（P＜0.001）。多变量分析结果一致（风险比，0.32；95%CI，0.18-0.57；P＜0.001）。
结论
我们分析了多个中心就诊的大量患者的 BE（长度≥1 cm）进展为 HGD 或 EAC 的情况，并进行了中位 6.4 年的随访。我们发现 SSBE 进展为 EAC 的年发生率（0.07%/年）低于 LSBE（0.25%/年）。我们建议延长 SSBE 患者的当前监测间隔。
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